TITLE: Effects of Isradipine and Diuretics on Early Carotid Atherosclerosis in Hypertension.AUTHOR:MIDAS Investigator Group.PUBLICATION: Presented at the 15th Scientific Meeting of the International Society of Hypertension. Melbourne, Australia, March 1994

TITLE: Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons with Isolated Systolic Hypertension: Final Results of the Systolic Hypertension in the Elderly Program (SHEP).AUTHOR:Shep Cooperative Research Group. PUBLICATION: JAMA 265:3255-3264 (1991)

TITLE: Shape and Area Measurement Considerations in the Assessment of Diabetic Plantar Ulcers.AUTHOR:Harvey N. MayrovitzPUBLICATION: Wounds (1997) 9(1), 21-28The author has developed and tested a formula for estimating the area of ulcers on the sole of the foot which reduces error to less than 1%, compared to 10% to 12% for conventional formulas. Measurements of ulcer size are important for monitoring ulcer healing, and the use of such an estimator eliminates the need for slow and costly measures, according to the author.

TITLE: Effects of Compression Bandaging on Leg Pulsatile Blood FlowAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Clinical Physiology (1997) 17, 105-117Leg external compression bandaging is the mainstay of skin wound treatment. Using a noninvasive method (nuclear resonance flowmetry), the authors studied the effects of foot-to-knee compression bandaging on pulsating arterial blood flow below the knee in 14 healthy participants. They found that bandaged leg pulsating blood flow increases, both in peak flow and pulse width, and this may be one of the reasons for the accelerated healing of bandaged skin ulcers.

TITLE: Final Outcome of the Multicenter Isradipine Diuretic Artherosclerosis Study (MIDAS): A Randomized Control TrialAUTHOR: N.O. Borhani, M. Mercuri, P.A. Borhani, V.M. Buckalew, M. Canossa-Terris, et al.PUBLICATION: JAMA (1996) 276, 785-791This multicenter 3-year study of 833 patients, in which Miami Heart Research Institute participated, found that both isradipine, a calcium channel blocker, and hydrocholorothiazide, a long-used diuretic antihypertensive agent, were equally effective in reducing blood pressure. Carotid IMT (intima media thickness) measured by B-mode ultrasound was used to determine whether the calcium channel blocker reduced the formation of atherosclerotic plaque. However, no reduction in the atherosclerosis progression was observed. MIDAS unexpectedly found that the diuretic tretament was associated with fewer serious vascular complications than the calcium channel treatment.

TITLE: The Effect of Pravastatin on Coronary Events after Myocardian Infarction in Patients with Average Cholesterol LevelsAUTHOR: F.M. Sacks, M.A. Pfeffer, L.A. Moye, J.L. Rouleau, et al. for the cholesterol and recurrent events trial investigatorsPUBLICATION: New England Journal of Medicine (1996) 335, 1001-1009CARE (Cholesterol and recurrent event) found that lowering cholesterol in patients with documented coronary heart disease and average cholesterol levels reduced the likelihood of additional heart attacks by 24%. Miami Heart Research Institute participated in this five-year study of over 4,100 coronary heart disease patients conducted in 80 centers throughout the United States and Canada. Patients on pravastatin (the drug of choice in this study) and diet also had 26% fewer coronary procedures, such as bypasses or angioplasties than did those on diet only. These benefits were observed among both smokers and nonsmokers, diabetics and nondiabetics and men and women.

TITLE: Pulsatile Blood Flow Asymmetry in Paired Human LegsAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Clinical Physiology (1996) 16, 495-505Leg blood flow has been extensively measured, but knowledge of the pulsating flow at specific leg cross-sections in normal or blood vessel impaired limbs is quite limited. Using a noninvasive method (magnetic resonance flowmetry), the authors sought to determine the symmetry in pulsating leg blood flow between paired legs and to assess the effect that lower extremity arterial disease might have on that symmetry. They found that, in people with healthy blood vessels, the pulsating blood flow in one leg mirrored the other. However, when lower extremity arterial disease was present, normal blood flow was disrupted (or disrupted more) in one leg, although the patients reported pain in both.

TITLE: Pulsatile Blood Flow Indices in Lower Extremity Arterial Disease: Leg Only Compared with Leg and Cardiac ParametersAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Vascular Surgery (1996) 30 (4): 337-344Peripheral arterial disease creates an obstruction to normal blood flow and is most common in the legs. The authors examined the cardiac stroke volume - the amount of blood pumped by the heart with each heartbeat (CSV) and leg blood flow measures (including both measures of flow per minute and flow per beat) in 100 patients with peripheral arterial disease in the legs. They found that, while CSV modifies the flow to the leg, measures of CSV do not improve the diagnostic information of peripheral arterial leg disease which leg blood flow measures, alone, provide.

TITLE: Effects of Sustained Regional Compression on Lower Extremity Skin MicrocirculationAUTHOR: Harvey N. Mayrovitz and Marie DelgadoPUBLICATION: Wounds (1996) 8(4): 111-117External compression of limbs is used therapeutically for a variety of conditions including the treatment of venous ulcers. However, there has been little systematic study of the impact of extended compression directly on blood flow through the microscopic blood vessels of the skin of the leg. In the present study, the authors applied sustained (40 minute) compression pressure (similar to that of bandages) to a region of the lower leg and used a noninvasive means (laser Doppler) to determine the effects of that pressure further down the leg. They found that sustained compression pressure significantly reduced blood flow. These findings reinforce the need for caution and close monitoring in therapeutic compression levels (as in bandages) in patients with impaired circulation.

TITLE: Effects of Foot-to-Knee Compression Bandaging on Sub-Bandage and Distal MicrocirculationAUTHOR: Harvey N. MayrovitzPUBLICATION: Sixth World Congress for Microcirculation (1996) 25-30This preliminary study of the effects of foot-to-knee bandaging on the circulation of blood through the microscopic blood vessels of the small toes indicates that small toe circulation might be impaired. However, measures of circulation change vary with posture and leg position.

TITLE: Effect of Compression Bandaging on Lower Extremity Skin MicrocirculationAUTHOR: Harvey N. Mayrovitz and Marie DelgadoPUBLICATION: Wounds (1996) 8(6): 200-207The authors conducted this study to clarify the effect of bandaging on leg blood flow. They found that a particular 4-layer type of bandaging system which is used clinically for treating certain types of skin ulcers, resulted in an immediate increase in blood flow to the bandaged area. However, a leg bandage reduced blood flow to the toes when the patient was lying down, though not when the bandaged leg was dangling. Since about one-fifth of patients with leg ulcers also have compromised leg circulation, the levels, benefits, and risks of compression therapy need to be considered on a patient-to-patient basis.

TITLE: A Preliminary Study to Evaluate the Effect of Pulsed Radio Frequency Field Treatment on Lower Extremity Peri-Ulcer Skin Microcirculation of Diabetic PatientsAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Wounds (1995) 7(3): 90-93Pulsed radio frequency energy has been used to accelerate healing of chronic wounds. The authors have applied this technique to the leg ulcers of diabetic patients and measured the flow of blood around the ulcers using laser Doppler. They found that the use of pulsed radio frequency energy causes an increase in the blood flow surrounding the ulcer. This increase in blood flow may be the cause of the accelerated healing produced by the pulsed radio frequency technique.

TITLE: Functional Microcirculatory Impairment: A Possible Source of Reduced Skin Oxygen Tension in Human Diabetes MellitusAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Microvascular Research (1996) 52: 115-126People with diabetes have reduced blood circulation carrying oxygen to their legs. The authors used a series of noninvasive measures to compare blood flow and oxygen levels in the legs of diabetic and nondiabetic subjects. They found no differences in the oxygen levels and blood flow in larger blood vessels but that both were significantly reduced in the microscopic blood vessels of the diabetic group.

TITLE: Standard and Near-Surface Laser-Doppler Perfusion in Foot Dorsum Skin of Diabetic and Nondiabetic Subjects with and without Coexisting Peripheral Arterial DiseaseAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Microvascular Research (1994) 48: 338-348The authors measured blood flow through the microscopic blood vessels of the skin of the upper foot using the laser Doppler technique, a noninvasive laser light based system. They found that by using a cup-like plastic adapter (or spacer) they were able to narrow the focus of the laser Doppler to the upper levels of the skin, where the nutritional function can best be studied. Use of the spacer improved measurements of the speed of blood flow but reduced the effectiveness of measures of the volume of blood flow.

TITLE: Assessment of the Microcirculation: Laser Doppler and Transcutaneous OxygenAUTHOR: Harvey N. MayrovitzPUBLICATION: Journal Vascular Technology (1994) 18(5): 269-275Two powerful tools to probe the circulation of blood in the tiniest vessels of the body are laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (TcPO2). LDF provides a quantitative measure of the movement of red blood cells in the skin's microscopic blood vessels. TcPO2 assesses the supply of oxygen, through the walls of these blood vessels, to the tissue cells according to their needs. Together, these techniques can help the researcher and clinician to assess the health of the microcirculatory system in the area measured and, by inference, throughout the body.

TITLE: Leg Blood Flow in Patients with Venous Ulcers: Relationship to Site and Ulcer AreaAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Wounds (1994) 6(6): 195-200Blood flow at five below-knee sites was measured in 10 patients, each with venous ulcers in only one leg prior to ulcer treatment and, again, after ulcer closure. Leg blood flow of the ulcer leg near the ulcer site was found to exceed that measured in the paired, nonulcer leg, while total below-knee flows were similar. This increase in ulcer-area blood flow increased with the size of the ulcer. After treatment, blood flow to the ulcer site was reduced, indicating that the metabolic demands of the site were probably reduced by treatment.

TITLE: Periwound Skin Microcirculation of Venous Leg UlcersAUTHOR: Harvey N. Mayrovitz and Parry B. LarsenPUBLICATION: Microvascular Research 48, 14-123 (1994)Skin measurements around ulcers show less oxygen, more carbon dioxide, and greater blood flow than normal. Using a noninvasive technique (laser Doppler), the authors found that this increased blood flow was due to both increased speed of flow and volume of flow in equal measure. Increased blood flow increases skin temperature and is accompanied by dramatically reduced oxygen pressure.

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